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 | This article may be too technical for most readers to understand. (July 2022) |
| Carpal tunnel syndrome | |
|---|---|
 | |
| Untreated carpal tunnel syndrome, showing shrinkage (atrophy) of the muscles at the base of the thumb. | |
| Specialty | Orthopedic surgery, plastic surgery, neurology |
| Symptoms | Numbness, tingling in the thumb, index, middle finger, and half of ring finger.[1][2] |
| Causes | Compression of the median nerve at the carpal tunnel[1] |
| Risk factors | Genetics, work tasks |
| Diagnostic method | Based on symptoms, physical examinations, electrodiagnostic tests[2] |
| Differential diagnosis | Peripheral neuropathy, Radiculopathy, Plexopathy |
| Prevention | None |
| Treatment | Wrist splint, corticosteroid injections, surgery[3] |
| Frequency | 5–10%[4][5] |
Carpal tunnel syndrome (CTS) is the collection of symptoms and signs associated with compression of the median nerve as it travels through the carpal tunnel in the wrist.[6] Most cases of carpal tunnel syndrome are idiopathic (having no known cause). [1] As with most structural issues, it can occur in both hands, and the strongest risk factor is genetic.[1]
Other conditions can cause CTS such as wrist fracture or rheumatoid arthritis. After fracture, swelling, bleeding, and deformity compress the median nerve. With rheumatoid arthritis, the enlarged synovial lining of the tendons causes compression.
The main symptoms are numbness and tingling in the thumb, index finger, middle finger and the thumb side of the ring finger.[1] People often report pain, but pain without tingling is not characteristic. Rather, the numbness can be so intense that it is described as painful.
Symptoms are typically most troublesome at night.[2] Many people sleep with their wrists bent, and the ensuing symptoms may lead to awakening.[7] Untreated, and over years to decades, CTS causes loss of sensibility and weakness and shrinkage (atrophy) of the muscles at the base of the thumb.
Work-related factors such as vibration, wrist extension or flexion, hand force, and repetition are proposed risk factors for CTS. But to date, there is mostly evidence of association with symptoms (CTS), not neuropathy, which is an important distinction. The only certain risk factor for CTS is genetics. All other risk factors are open to debate. It is important to consider CTS separately from diseases such as rheumatoid arthritis.[8][5][3]
Diagnosis of CTS can be made with a high probability based on characteristic symptoms and signs, and can be measured with electrodiagnostic tests.[9]
People wake less often at night if they wear a wrist splint. Injection of corticosteroids may or may not alleviate better than simulated (placebo) injections.[10][11] There is no evidence that corticosteroid injection sustainably alters the natural history of the disease, which seems to be a gradual progression of neuropathy.
Surgery to cut the transverse carpal ligament is the only known disease modifying treatment.[3]
- ^ a b c d e Burton C, Chesterton LS, Davenport G (May 2014). "Diagnosing and managing carpal tunnel syndrome in primary care". The British Journal of General Practice. 64 (622): 262–263. doi:10.3399/bjgp14x679903. PMC 4001168. PMID 24771836.
- ^ a b c "Carpal Tunnel Syndrome Fact Sheet". National Institute of Neurological Disorders and Stroke. January 28, 2016. Archived from the original on 3 March 2016. Retrieved 4 March 2016.
- ^ a b c American Academy of Orthopaedic Surgeons (February 29, 2016). "Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline". Archived from the original on March 30, 2020. Retrieved March 5, 2016.
- ^ Bickel KD (January 2010). "Carpal tunnel syndrome". The Journal of Hand Surgery. 35 (1): 147–152. doi:10.1016/j.jhsa.2009.11.003. PMID 20117319.
- ^ a b Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, et al. (November 2016). "Carpal tunnel syndrome: clinical features, diagnosis, and management". The Lancet. Neurology (Review). 15 (12): 1273–1284. doi:10.1016/S1474-4422(16)30231-9. PMID 27751557. S2CID 9991471.
- ^ Genova A, Dix O, Saefan A, Thakur M, Hassan A (March 2020). "Carpal Tunnel Syndrome: A Review of Literature". Cureus. 12 (3): e7333. doi:10.7759/cureus.7333. PMC 7164699. PMID 32313774.
- ^ "Carpal Tunnel Syndrome - Symptoms and Treatment - OrthoInfo - AAOS". www.orthoinfo.org. Retrieved 2023-08-18.
- ^ Shiri R (December 2014). "Hypothyroidism and carpal tunnel syndrome: a meta-analysis". Muscle & Nerve. 50 (6): 879–883. doi:10.1002/mus.24453. PMID 25204641. S2CID 37496158.
- ^ Cite error: The named reference
Graham 2587–2593was invoked but never defined (see the help page). - ^ Boyer MI (October 2008). "Corticosteroid injection for carpal tunnel syndrome". The Journal of Hand Surgery. 33 (8): 1414–1416. doi:10.1016/j.jhsa.2008.06.023. PMID 18929212.
- ^ Huisstede BM, Randsdorp MS, van den Brink J, Franke TP, Koes BW, Hoogvliet P (August 2018). "Effectiveness of Oral Pain Medication and Corticosteroid Injections for Carpal Tunnel Syndrome: A Systematic Review". Archives of Physical Medicine and Rehabilitation. 99 (8): 1609–1622.e10. doi:10.1016/j.apmr.2018.03.003. PMID 29626428. S2CID 4683880.
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